CMS Announces Immediate, Aggressive Enforcement for Special Focus Facilities (SFF) Participants

Posted on October 25, 2022 by LeadingAge

On Friday, Oct. 21, CMS announced new actions "to significantly strengthen accountability for nursing homes in the Special Focus Facilities (SFF) Program." According to the White House press release, the "SFF Program already provides more frequent inspections of these nursing homes, but more action is needed to ensure these nursing homes improve."

Effective immediately upon the announcement, the SFF Program reforms include the following reforms.

Increased Penalties for Nursing Homes that Fail to Improve

CMS will use escalating penalties for violations, including considering facilities with citations for dangerous violations in two successive inspections for termination from Medicare and/or Medicaid funding.

For example, an "SFF with continued noncompliance and little or no demonstrated efforts to improve performance will have more severe enforcement remedies than facilities that have taken aggressive actions to bring systemic change and improve performance." Increasing severity could mean a higher CMP than was imposed for the earlier noncompliance or increasing from one remedy to more than one remedy being imposed.

Additionally, CMS will consider facilities' efforts to improve (or lack thereof) when considering discretionary termination from Medicare and/or Medicaid programs." Discretionary termination will be considered if any two surveys (standard health, complaint, LSC, or EP) result in deficiencies that pose IJ to one or more residents while the facility is in the SFF program.

Increased Safety Standards for Improvement and Post-Program Graduation

CMS has increased the requirements that an SFF must meet to be successful and graduate from the program. And for those SFFs that graduate from the program, CMS will continue close scrutiny of the facility for at least three years.

SFFs will not graduate if any of the following occurs:

• Any standard health survey results in deficiencies cited at an S/S level of "F" or higher
• Any LSC or EP survey results in deficiencies cited at an S/S level of "G" or higher
• 13 or more total deficiencies are cited on any survey (standard health, LSC, EP, or complaint)
• Intervening complaint surveys with 13 or more total deficiencies or any deficiencies cited at an S/S level of "F" or higher

Increased Technical Assistance

CMS is also increasing its engagement with these SFF Program participants through direct and immediate outreach by CMS officials upon their selection as an SFF to help them understand how to improve and access support resources like CMS Quality Improvement Organizations.

For more detailed information about these SFF Program changes, see QSO 23-01-NH.